Last Updated on February 7, 2019 by FRCEM Intermediate

Overview

• Intussusception is the invagination of a proximal segment of bowel into the distal bowel lumen.
• The commonest occurrence is a segment of ileum moving into the colon through the ileo-caecal valve.
• Any age but commonly occurs in the 2 month to 2 years (peak 5 to 9 months).

Clinical features

• Intermittent pain which is colicky, severe and may be associated with the child drawing up the legs.
• Episodes typically occur 2-3 times/hour and may increase over the next 12-24 hours
• During these episodes of crying the child may look pale.
• vomiting is usually a prominent feature, but bile stained vomiting is a late sign
• Bowel motions
  • Blood and/or mucus
  • Classic red currant jelly stool is a late sign

Examination

• Abdominal mass – sausage shaped mass RUQ or crossing midline in epigastrium or behind the umbilicus, palpable in about two thirds of children.
• Distended abdomen
• Stool: Bloody stool/occult blood positive
• absence of bowel in the right lower quadrant (Dance’s sign)
• Signs of an acute bowel obstruction
• Hypovolaemic shock is a late sign

Investigation

• Plain abdominal X-ray – to exclude perforation or bowel obstruction
  • visible abdominal mass, abnormal wind pattern, dilated bowel loops, air-fluid level
  • Target sign – 2 concentric circular radiolucent lines usually in the right upper quadrant
  • Crescent sign – a crescent-shaped lucency usually in the left upper quadrant with a soft tissue mass

• Gas insufflation enema (or contrast enema)
  • Diagnostic investigation of choice if high level of suspicion
  • This intervention is both diagnostic and therapeutic
• Ultrasound scan
  • soft-tissue mass, ‘doughnut sign’, pseudokidney/sandwich appearance, ‘target sign’

• Routine blood tests
  • Blood glucose
  • Blood group and hold prior to theatre
  • FBE and U&E may be useful if the child looks unwell

Management

• Analgesia
• Nil by Mouth
• Nasogastric tube to decompress the bowel
• Start IV rehydration
• Refer to pediatric surgeons

Complications

• Ischaemia, infarction and necrosis
• Obstruction
• Perforation
• Peritonitis
• Sepsis
• Hemorrhage